Treatment Procedures / Gum Problems

Periodontal (Gum) Disease: Causes, Symptoms, and Treatments

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What causes periodontal disease?

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless "plaque" on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form bacteria-harboring "tartar" that brushing doesn't clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar./p>

Gingivitis

The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called "gingivitis." In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold the teeth in place.

Periodontitis

When gingivitis is not treated, it can advance to "periodontitis" (which means "inflammation around the tooth.") In periodontitis, gums pull away from the teeth and form "pockets" that are infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body's enzymes fighting the infection actually start to break down the bone and connective tissue that hold the teeth in place. If not treated, the bones, gums, and connective tissue that support the teeth get destroyed. The teeth may eventually become loose and have to be removed.

Risk Factors

Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of periodontitis. Additionally, smoking can lower the chances of success of some treatments.

Hormonal changes in girls/women These changes can make gums more sensitive and make it easier for gingivitis to develop.

Diabetes People with diabetes are at higher risk for developing infections, including periodontal disease.

Stress Research shows that stress can make it more difficult for our bodies to fight infection, including periodontal disease.

Medications Some drugs, such as antidepressants and some heart medicines, can affect oral health because they lessen the flow of saliva. (Saliva has a protective effect on teeth and gums.)

Illnesses Diseases like cancer or AIDS and their treatments can also affect the health of gums.

Genetic susceptibility Some people are more prone to severe periodontal disease than others.

Who gets periodontal disease?

People usually don't show signs of gum disease until they are in their 30s or 40s. Men are more likely to have periodontal disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.

What can I do to prevent gum disease?/h2>
  • Here are some things you can do to prevent periodontal diseases:
  • Brush your teeth twice a day (with a fluoride toothpaste)
  • Floss every day
  • Visit the dentist for routine check-up and professional cleaning
  • Eat a well-balanced diet
  • Don't use tobacco products



How do I know if I have periodontal disease?

Symptoms are often not noticeable until the disease is advanced. They include:

  • Bad breath that won't go away
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth

How is periodontal disease treated?

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. Additionally, modifying certain behaviors, such as quitting tobacco use, might also be suggested as a way to improve treatment outcome.

Deep Cleaning (Scaling and Root Planing)

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing helps you get rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease.

Medications

Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on the severity of gum disease, the dentist or periodontist may still suggest surgical treatment.

Surgery

Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain, following treatment with deep cleaning and medications. A periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again.



Bone and Tissue Grafts. In addition to flap surgery, your periodontist may suggest bone or tissue grafts. Grafting is a way to replace or encourage new growth of bone or gum tissue destroyed by periodontitis. A technique that can be used with bone grafting is called guided tissue regeneration, in which a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow.



Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including severity of the disease, ability to maintain oral hygiene at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.

Can periodontal disease cause health problems beyond the mouth?

Recent studies suggest gum disease may contribute to or be warning signs of potentially life threatening conditions such as:

  • Heart Disease and Stroke- Studies suggest gingivitis may increase the risk of heart disease and stroke because of the high levels of bacteria found in infected areas of the mouth. As the level of periodontal disease increases, the risk of cardiovascular disease may increase with it. Other studies have suggested that the inflammation in the gums may create a chronic inflammation response in other parts of the body which has also been implicated in increasing the risk of heart disease and stroke.
  • Diabetes- People with diabetes often have some form of gum disease, likely caused by high blood glucose. People with diabetes need to take extra care to ensure proper brushing and flossing techniques are used to prevent the advancement of the gum disease. Regular check-ups and cleanings with your dental hygienist should be followed.
  • Chronic Kidney Disease- A study, conducted by Case Western Reserve University, suggests that people without any natural teeth, known as edentulous, are more likely to have chronic kidney disease (CDK), than people with natural teeth. CDK affects blood pressure potentially causing heart disease, contributed to kidney failure, and affects bone health.
  • Preterm Birth- Babies that are born premature — before 37 weeks of gestation — may face numerous health complications. Research indicates that women with periodontal disease are three to five times more likely to have a baby born preterm as compared to women without any form of gum disease.

Women are more susceptible to gingivitis when pregnant and should follow their regular brushing habits, and continue with dental cleanings and examinations.